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Pelvic venous disorder represents an as common as challenging clinical scenario because of the blurred borders between pelvic region and lower limb treatment target, because of the subtle and aspecific signs and symptoms, because of the lack of large randomized comparative trials providing clarity on the best practice and strong recommendations. Herein we present pathophysiology and clinical considerations on the lower limb varicosities of pelvic origin, suggesting possible management strategies based on clinical manifestation, ultrasound detection and targeted sclerotherapy. Large studies are needed to identify the best diagnostic parameters guiding the best strategy and highlighting the most reliable reported outcomes from such heterogeneous patients. [Turk J Vasc Surg 2023; 32(0.000): 24-7]